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Pure tissue inguinal hernia repair with the use of biological mesh: a 10-year follows up. A prospective study



The long-term results for inguinal hernia repair (IH) with the use of biological mesh (BM) are not known. A prospective study was started in 2003–2004 to evaluate the results of pure tissue (IH) repair with the use of biological mesh with a 10-year follow-up.


From March 2003 to December 2004, all patients with IH who presented to the office, including incarcerated and recurrent IH, not excluding any, underwent pure tissue IH repair reinforced with a BM. During this period, 101 patients (87/male, 14/female) underwent 104 IH repair with a continuous suture of transversalis to transversalis fascia repair reinforced with BM of porcine intestinal submucosal origin (Surgisis, Cook) and were followed up for 10 years.


There were 104 IH, 90 electives (86%), 2 incarcerated (1.9%), and 12 recurrent (11%). Follow-up was scheduled at 1 week, 1 month, 1 year, 3 years, 7 years and 10 years., in 100%, 100%, 99%, 93%, 89% and 85% of the patients, respectively. Recurrence was observed in 2/104 (1.9%): one recurrence at 1 week in a patient with bilateral IH and one at 7 years. The mean recovery time was 1.2 days (range 1–5 days). Mortality was 0(0%). Complications: six hematic infiltration to the scrotum and one to the vulva, all resolved spontaneously; wound infection 0(0%); urinary retention 11/104 (10.5%); inguinal scrotal hypoesthesia 7/104(6.7%), improved after 4–6months; asymptomatic fever of 39°C, 2/104 patients (1.9%), responded to a single dose of 4 mg betamethasone. No long-term inguinal pain complaint was found except for one patient with a recurrent IH.


The use of BM to reinforce a pure tissue IH repair is safe and effective. The recurrence rate is comparable to short- and long-term synthetic mesh IH repair with less complications and pain than the use of synthetic mesh as reported in the literature.

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Correspondence to B. Ravo.

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Conflict of interest

None of the authors has any financial relationship to disclose.

Ethical approval

At our institution, this study did not require an ethical committee approval because it is not a randomized study and the biological material used is well known and approved by FDA and the European TUV as early as year 2000.

Human and animal rights

All procedure were performed according to ethical standards and approved by ethical committee of our institution. No procedure were performed on animals in this study.

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All patients signed for informed consent.

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Ravo, B., Falasco, G. Pure tissue inguinal hernia repair with the use of biological mesh: a 10-year follows up. A prospective study. Hernia 24, 121–126 (2020). https://doi.org/10.1007/s10029-019-01976-y

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  • Pure tissue inguinal hernia repair
  • Biological mesh
  • Recurrence inguinal hernia
  • Synthetic mesh complications
  • Pain